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RENAL_PHARM > NSAIDs and Acute Renal Failure > Flashcards

NSAIDs and Acute Renal Failure Flashcards

1
Q

Drug elimination in the kidneys is normally impaired in the elderly due to what 2 things

A

reduced renal blood flow

decreased GFR

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2
Q

Dosage adjustment according to renal function is indicated for many drugs in order to avoid what 3 things

A

accumulation of drugs/metabolites
adverse reactions
aggravation of renal impairment

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3
Q

Renal dysfunction alters renal excretion of drug/metabolites and also leads to modification in what 3 things of drug substances?

A

distribution
transport
biotransformation

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4
Q

What are the 3 processes that can potentially contribute to the renal clearance of a drug?

A

glomerular filtration
tubular secretion
tubular reabsorption

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5
Q

perfusion rate limited

A

the extraction ratio is not limited to the unbound fraction of the drug

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6
Q

capacity rate limited

A

the extraction ratio is limited by the reversible binding of the drug to plasma proteins or its location in red blood cells

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7
Q

The tubular reabsorption of drugs is considered a ____________ process for the majority of drugs and drug metabolites

A

passive

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8
Q

What is the driving force that powers the tubular reabsorption of drugs?

A

the extensive reabsorption of filtered water long the tubule

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9
Q

Name the peptide transporters that are expressed on the apical membrane of renal epithelial cells that mediate the tubular reabsorption of peptide-like drugs like beta lactam and ACE inhibitors

A

PEPT1, PEPT2

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10
Q

GFR of normal renal function

A

> 80

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11
Q

GFR mild renal impairment

A

50-80

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12
Q

GFR moderate renal impairment

A

30-50

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13
Q

GFR severe renal impairment

A

<30

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14
Q

GFR of end-stage renal disease

A

REQUIRES DIALYSIS

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15
Q

NSAIDs are used by what percentage of people over 65 every day?

A

20-30%

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16
Q

What are 4 reasons adults are at a higher risk for experiencing adverse effects of NSAIDs

A

higher use
increased prevalence of conditions exacerbated by NSAIDs (HTN, CHF, Renal insuff.)
larger numbers of comorbid conditions
higher use of other meds

17
Q

______________ declines with age irrespective of the use of drug therapy

A

RENAL FUNCTION

18
Q

__________________locally modulate the effects of both systemic and locally produced vaso-constrictor hormones

A

eicosanoids

19
Q

what ar ethe 2 predominant mediators of physiologic activity in the kidney

A

PGI2, PGE2

20
Q

what do PGI2 and PGE2 do in the kidney?

A

induce vasodilation of interlobular arteries, affarent and efferent arterioles and glomeruli

21
Q

why is risk of NSAID-associated acute renal failure in healthy people negligible

A

because the basal PG production is low in healthy people

22
Q

what are some risk factors that render the kidney prostaglandin dependent and so place pts at risk of ARF when they take NSAIDs

A 
true intravascular volume depletion
vomiting
diarrhea
diuretics
effective intravascular volume depletion
congestive heart failure
cirrhosis
kidney disease
ARF
CKD
meds
ACE inhibitors
ARBs
old age
23
Q

How do PGI2 and PGE2 preserve GFR

A

by antagonizing arteriolar vasoconstriction and blunting mesangial and podocyte contraction induced by endogenous vasopressors

24
Q

the risks of lowering GFR in pts with underlying pathologic states increases with the _____________- and the _________________ of NSAID consumption

A

dose, duration

25
Q

Explain how PG prod. is increased in CKD

A

induced by intrarenal mechanisms activated to increase perfusion to remnant nephrons

26
Q

So if you use an NSAID in a pt with CKD what will happen

A

they will have acute reductions in RBF and GFR

27
Q

what kind of drugs increase the risk for ARF when given with NSAID

A

ACE and ARB

28
Q

PGE2 decreases cellular transport of what in the TALH and CD

A

sodium chloride

29
Q

an increase in renal sodium excretion and a decrease in medullary tonicity are the direct result of what

A

PGE2

30
Q

PGE2 and PGI2 also stimulate _________secretion , which ultimately activates RAAS

A

renin

31
Q

PGE2 and PGI2 also inhibit__________- synthesis and oppose the action of ADH facilitating water excretion

A

cyclinc-AMP

32
Q

What is the net effect of PGs on the loop of henle and distal nephron

A

leads to mild dose-dependent increase in BP

33
Q

what kinds of pts are at a higher risk to develop severe HTN

A 
elderly
pre-existing HTN
salt-sensitive pts
pts with renal failure
pts with renovascular HTN
34
Q

COX-2 inhibitors are equivalent to NSAIDs with respect to their

A

nephrotoxic potential

35
Q

________________ is manifest in terms of tubular epithelial necrosis secondary to altered renal hemodynamics

A

ACUTE TOXICITY

36
Q

NSAIDs are also associated with what that is thought to be the result of reaction to individual NSAID chemical structure

A

interstitial nephritis

RENAL_PHARM (3 decks)

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